India wages hi-tech war on ancient TB scourge

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NEW DELHI — Shammo Khan walks into a dusty courtyard that reeks of garbage, searching for the fingerprint of a man exhausted by HIV, drug withdrawal, and the tuberculosis lesions hijacking his lungs.

She opens her laptop on his rope bed, prods the emaciated man to log in on a fingerprint reader, and watches him slowly and painfully swallow a handful of TB drugs in an experimental program harnessing new technology to combat an ancient killer still ravaging India.

Private companies, aid groups, and the government have embarked on a flurry of innovation to modernize India’s archaic antituberculosis campaign and fight the spread of frightening new drug-resistant strains threatening to cause a public health nightmare.

The government is replacing its haphazard paper system of registering TB patients with a Web-based database that theoretically could track every dose of medicine given to patients — and send them text messages when they miss one.

New tests powered by computer chips are being rolled out that can quickly identify drug-resistant patients so they can be given the proper treatment with a longer course of different medicines. And Operation ASHA, an independent health group, is using its fingerprint verification program to ensure patients take their full course of medicine to prevent the disease from mutating into a stronger strain.

‘‘There’s more innovation in the last year than in the prior decade in TB control,’’ says Peter Small, a tuberculosis expert at the Bill and Melinda Gates Foundation offices in India.

In addition, the government is proposing to quadruple ­tuberculosis funding, is expanding its lab network, and has ordered doctors for the first time to report all new TB cases.

India is struggling with more than a quarter of the world’s new tuberculosis cases and has become an epicenter of new drug-resistant strains. Last year, doctors in Mumbai reported 12 cases of TB that had mutated into a nearly untreatable strain because of mistreatment and missed doses.

Despite the array of new tools, Zarir Udwadia, a Mumbai doctor who uncovered some of those mutant strains, said he remained pessimistic about ­India’s ability to conquer drug-resistant tuberculosis. He doubted the government could exercise enough control over a health system where quacks with no training treat TB ­patients, and pharmacists routinely give out antibiotics without prescriptions.

Operation ASHA is working to prevent the creation of more new strains by fortifying the centerpiece of India’s traditional anti-TB campaign, a program that pays counselors and private groups to verify patients are taking their medicine.

Counselors only get paid for those who complete the standard six-month course of treatment, giving them an incentive to lie when patients drop out. Government statistics provided by the counselors show only 6 percent of patients don’t finish treatment. Independent studies show defaults ranging from 15 percent to 33 percent.

‘‘There is no transparency, no accountability in the work they are doing,’’ said Shelly Batra, president of Operation ASHA.

To make sure counselors do their jobs, her group joined Microsoft Research and the nonprofit Innovators in Health to develop a program that uses cheap fingerprint readers to ensure patients actually meet with counselors to take their meds.

From the porch of a tailor shop in a southern New Delhi slum, Shammo Khan was running one of the 35 Operation ASHA centers using fingerprint-monitoring in the capital and two other cities.

Children, the elderly, and hip, young men logged in by pressing their fingers onto the glass of a print reader connected to a handheld computer. Khan, 22, then handed them their medicine and watched them wash it down.

She checked the computer throughout her shift to see who had yet to come, and at the end of each day got an automatic text message telling her whom to chase down.

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